Elbow instability test

The elbow instability test is a test to assess rotatory instability of the elbow, as well as ulnar-humeral and posterolateral dislocation.

• Required Material: A physiotherapy couch or chair.

• Procedure: For the assessment of elbow instability, different tests are carried out:
• a) Valgus test: The person being assessed is seated with the arm in extension with a slight elbow flexion of 10-20º and the shoulder in maximum external rotation. The forearm is positioned in supination (palm upwards). The evaluator must perform two types of grasps by applying a force in opposite directions to the elbow; one in the medial or inner region of the arm and another at the level of the forearm by performing an adduction (inward movement).
• b) Varus test: The subject is seated with the arm to be assessed in 10-20º flexion and the shoulder in maximum internal rotation. A grasp is made on the lateral aspect of the elbow to perform an abduction of the forearm (outward movement) and assess the stability of the medial collateral ligament.
• c) Pivot-shift test: The subject lies on the stretcher in the supine position (face up), with the shoulder of the elbow to be assessed in flexion of 160º-180º and in maximum external rotation. The assessor stands behind the subject to perform a distal grasp on the forearm and a proximal grasp on the elbow. The evaluator, starting from full elbow extension and maximal forearm supination, must perform a valgus force as elbow flexion is performed to assess postero-lateral rotational stability.

• Assessment: The test is considered abnormal or positive when any pain, discomfort or instability is evident throughout the manoeuvre. If no pain is present the test is considered normal or negative.

• Remarks: In the different tests, the stability/instability between the contralateral side and the evaluated structure (collateral ligaments, joint subluxation or dislocation) should be compared.